Provider Demographics
NPI:1679576144
Name:HAGENEY, VICTORIYA K (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTORIYA
Middle Name:K
Last Name:HAGENEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VICTORIYA
Other - Middle Name:K
Other - Last Name:ABRAMOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:100 NICOLSON DR
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-4130
Mailing Address - Country:US
Mailing Address - Phone:717-379-0269
Mailing Address - Fax:484-565-1513
Practice Address - Street 1:255 W LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1763
Practice Address - Country:US
Practice Address - Phone:717-379-0269
Practice Address - Fax:484-565-1513
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD417027207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001867438Medicaid
PAH51297Medicare UPIN
PA052501Medicare ID - Type Unspecified